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Health and Human Services Secretary Alex Azar. Photo: Chip Somodevilla/Getty Images

The Trump administration's recent proposal to change the way drug prices are negotiated in Medicare and Medicaid is operating under a tight timeline, and some are skeptical that it can be solidified by 2020.

Why it matters: The new policy would raise Medicare Part D premiums once it takes effect. For now, the premium hike is expected to be announced this fall. But if implementation is delayed, that hike could come in the fall of 2020 — right before the presidential election.

The big picture: The proposal would change the way drug prices are negotiated behind the scenes, phasing out the drug rebates collected by insurers and replacing them with discounts to consumers at the pharmacy counter.

  • Insurers currently use rebates to lower premiums. The new rule is expected to lower out-of-pocket costs for seniors who currently pay a lot for their drugs, but raise premiums for Medicare Part D by as much as 25% over the next decade, per the federal government's analysis.
  • While the change is expected to take place beginning in January of next year, insurance plans are developed and locked in over a rigid timeline that essentially must be completed by June.
  • "Health insurance providers are concerned over the timeline of implementing for 2020," said Kristine Grow, a spokeswomen for America's Health Insurance Plans.

Details: The public has 60 days to weigh in, which will be followed by another 60-day period for HHS to evaluate the comments. A final rule should come out around May.

  • Meanwhile, companies have to submit their drug plans by May, and final bids for Medicare drug plans have to be submitted by June. That leaves almost no time for the industry to reconcile the rule with their 2020 plans.

The bottom line: Part D premiums are heavily subsidized, but the politics of raising seniors' health care costs are never good.

  • Insurers won't be happy to find themselves in the line of fire regardless of when the changes take place.
  • Democrats would love to weaponize seniors' health care costs right ahead of the 2020 elections. And Republicans can't be excited to have that problem on their hands, though they could also see some benefit from seniors who see their costs at the pharmacy counter fall.

Go deeper

DOJ watchdog to probe whether officials sought to alter election results

Donald and Melania Trump exit Air Force One in West Palm Beach, Fla., on Jan. 20. Photo: Alex Edelman/AFP via Getty Images

The Justice Department's inspector general will investigate whether any current or former DOJ officials "engaged in an improper attempt to have DOJ seek to alter the outcome" of the 2020 election, the agency announced Monday.

Driving the news: The investigation comes in the wake of a New York Times report that alleged Jeffrey Clark, the head of DOJ's civil division, had plotted with President Trump to oust acting Attorney General Jeffery Rosen in a scheme to overturn the election results in Georgia.

2 hours ago - Podcasts

Google's chief health officer Karen DeSalvo on vaccinating America

Google on Monday became the latest Big Tech company to get involved with COVID-19 vaccinations. Not just by doing things like incorporating vaccination sites into its maps, but by helping to turn some of its offices and parking lots into vaccination sites.

Axios Re:Cap goes deeper into what Google is doing, and why now, with Dr. Karen DeSalvo, Google's chief health officer who previously worked at HHS and as health commissioner for New Orleans.

Biden signs order overturning Trump's transgender military ban

Photo: Tom Brenner/Getty Images

President Biden signed an executive order on Monday overturning the Trump administration's ban on transgender Americans serving in the military.

Why it matters: The ban, which allowed the military to bar openly transgender recruits and discharge people for not living as their sex assigned at birth, affected up to 15,000 service members, according to tallies from the National Center for Transgender Equality and Transgender American Veterans Association.

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